The incidence of hypotension is increased in patients 65 years of age or older. The incidence of hypotension following the epidural administration of a 5 mg/mL, 7.5 mg/mL and 10 mg/mL solutions of ropivacaine (the active ingredient contained in Naropin SDV) were 32.2%, 43.2%, 51.5%, respectively, in patients under 65 years of age, and 68.9%, 69.1%, 68.4%, respectively, in patients 65 years of age or older.[Ref]

High doses or unintentional intravascular injection may lead to decreased cardiac output, heart block, hypotension, bradycardia, cardiac arrhythmias, and cardiac arrest. In comparative studies, ropivacaine has been shown to be less cardiotoxic and arrhythmogenic than bupivacaine.

The incidence of hypotension is dose related. In patients under 65- years- old the incidence of hypotension following administration of 5 mg/mL, 7.5 mg/mL, and 10 mg/mL ropivacaine solutions was 38.7%, 49.2% and 54.6%, respectively.

Hypotension occurs at a higher incident rate in females as compared to males. It was reported, following epidural administration, in 54.3% of females versus 38.9% of males.[Ref]

Nervous system

Seizure activity in an obstetrical patient who had been treated with ropivacaine (the active ingredient contained in Naropin SDV) has been reported. One case involved a 26- year- old female who received an aggregate dose of 279 mg of ropivacaine. She developed oculogyric movements and slurred speech that proceeded to twitching of the face and arms. The seizure was successfully treated with thiopental sodium 400 mg, the patient was given general anesthesia, and the child was delivered without further incident.

A 38- year- old woman was reported to have developed Transient Neurologic Symptom (TNS) following intrathecal administration of 10 mg at the L2-L3 while in the right lateral decubitus position. The patient gradually recovered over a 6- week period.

Clinicians should be aware that restlessness, anxiety, incoherent speech, lightheadedness, paresthesias, dizziness, blurred vision, tremors, twitching, depression, and drowsiness may be early warning signs of central nervous system toxicity. The mean (min - max) maximum tolerated total and free arterial plasma concentrations following intravenous administration in humans were 4.3 (3.4 - 5.3) and 0.6 (0.3 - 0.9) respectively, at which time twitching (representative of moderate central nervous system toxicity) was noted.

Headache, dizziness, and hypoesthesia occur at a higher incident rate in females as compared to males. Headache was reported, following epidural administration, in 8.1% of females versus 4.8% of males. Dizziness was reported, following epidural administration, in 2,2% of females versus 1.1% of males. Hypoesthesia was reported, following epidural administration, in 2% of females versus 0.6% of males.[Ref]

Gastrointestinal

Gastrointestinal side effects have frequently included nausea (24.8%) and vomiting (11.6%). Fecal incontinence and tenesmus have been reported rarely.[Ref]

Nausea and vomiting may have resulted from other concomitant surgical anesthetics.

Nausea and vomiting occur at a higher incident rate in females as compared to males. Nausea was reported, following epidural administration, in 39.4% of females versus 6.5% of males. Vomiting was reported, following epidural administration, in 14.6% of females versus 2.3% of males.[Ref]

Other

Other side effects have frequently included fever (9.2%), pain (8%), postoperative complications (7.1%), headache (5.1%), pruritus (5.1%), back pain (5%), rigors (2.5%), breast-feeding disorder (1.3%), poor/failed progression of labor (1.4%), and cramps (1 to 5%). Hypothermia, malaise, accident and/or injury, uterine atony, tinnitus, and hearing abnormalities have been reported rarely. Metallic taste has also been reported, but may also be an early sign of central nervous system toxicity. Transient increases in body temperature (>38.5 C) have been reported rarely following epidural administration. This effect occurred more frequently at doses exceeding 16 mg/hr.[Ref]

Back pain, chills, fever, pruritus, and pain occur at a higher incident rate in females as compared to males. Back pain was reported, following epidural administration, in 10.1% of females versus 6.5% of males. Chills was reported, following epidural administration, in 4.4% of females versus 1.4% of males. Fever was reported, following epidural administration, in 4% of females versus 0.8% of males. Pruritus was reported, following epidural administration, in 4% of females versus 0.3% of males. Pain was reported, following epidural administration, in 3% of females versus 1.1% of males.[Ref]

Genitourinary

Genitourinary side effects, occurring in 1% to 5% of patients, have included urinary retention, urinary tract infection, and oliguria. Urinary incontinence and micturition disorder have been reported rarely.[Ref]

Dermatologic

Dermatologic side effects have rarely included rash and urticaria.[Ref]

Musculoskeletal

Ocular

Psychiatric

Psychiatric side effects have rarely included agitation, hallucination, emotional lability, and nightmares.[Ref]

Respiratory

Respiratory side effects have rarely included rhinitis (1.1%), bronchospasm, and coughing.[Ref]

Hypersensitivity

Hypersensitivity side effects have rarely included life-threatening anaphylaxis. Allergic cross-sensitivity between amide-type anesthetics has been reported. A delayed hypersensitivity reaction to epidural ropivacaine (the active ingredient contained in Naropin SDV) has been reported.[Ref]

General

In general, most side effects due to ropivacaine (the active ingredient contained in Naropin SDV) are transient and mild. Most effects are similar to the type and frequency of those seen with bupivacaine and tend to be dose related.[Ref]

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